Ear, Nose, Throat (ENT) Cancers

ENT (Ear, Nose, Throat) cancers are also known as head and neck cancers. They are a group of cancers that affect the soft tissue organs in the head and neck region.

According to the National Registry of Diseases Office, nasopharyngeal cancer (nose cancer), thyroid cancer, and lymphoid cancer (which often occurs in the neck) rank in the 10 most common cancers in Singapore. Nose cancer is more common in men, thyroid cancer is more common in women, and lymphoid cancers occur in both sexes. There is about a 1 in 100 chance of developing one of these cancers by the age of 75.

Lump in the neck – Most lumps developing in the neck are benign (non-cancerous). However, a lump that persists for more than 2 weeks, or is painless, or keeps growing, should be seen by a doctor.

Lumps in the neck can occur in nose, thyroid and lymphoid cancers, as well as other ENT cancers. The position of the lump in the neck may give a clue to its cause. For example, a lump in the lower front part of the neck may arise from the thyroid gland, particularly if it moves up and down when swallowing. If you feel a neck lump, don’t panic, because it is more likely due to a non-serious cause such as an inflamed gland, but it is worth having it checked by your doctor.

Nosebleeds – Nosebleeds usually occur because of trauma to the nose lining, often due to dry weather, infection or allergy, which can cause people to rub or scratch their noses more. However nosebleeds can also be a sign of cancer, in particular nose cancer. Especially if bleeding is persistent, scanty, or associated with a headache or unusual smell, then it is important to get checked. Nosebleeds sometimes drain backwards into the throat, causing blood-stained phlegm.

Swelling or ulcer in the mouth – A swelling, ulcer or sore area in the mouth that does not go away within a week should be evaluated by a doctor. This is particularly important if accompanied by a lump in the neck. Ulcers that come and go in different areas of the mouth are typically non-cancerous, and known as aphthous ulcers.

Hoarse voice – Hoarseness can occur with cancers of the voice box. It can also be a sign of thyroid cancer. This is because nerves to the vocal cords run closely behind the thyroid gland and can be affected by cancer within the gland. While most voice changes are not due to cancer, you should not take the chance, and if the hoarse voice persists, you should see your doctor.

Difficulty swallowing – A feeling that something is stuck in the throat, or even difficulty swallowing food can be a sign of cancer of the throat, and should be evaluated by a doctor. A swallowing x-ray or an oesophagoscopy (direct examination of the food passage with a scope) may be necessary to find the cause.

This can be carried out in the clinic using a technique known as transnasal oesophagoscopy (TNE). This involves passing a thin flexible camera through the nose while the patient is awake, to view the oesophagus and stomach.

Pain or blockage in the ear – Pain or blockage in the ear does not always represent a problem with the ear, but can be due to disease or a tumour in the nose or throat. Nose cancers can present with a blocked ear or sometimes unexplained pain or discomfort around the ear as the only symptom. Examining the ear will help make the distinction between a problem within the ear or a surrounding area.

If you have any of the symptoms above, a full ENT examination is recommended.

When there is a lump in the neck, its cause can often be determined by having it examined by an experienced doctor. Some lumps can be left alone or treated with medication, while others may require further investigation. In the case of a thyroid lump, an ultrasound scan and fine needle biopsy can help determine the likelihood of cancer, and therefore the need for surgical removal. Not all neck lumps must be removed, but sometimes surgery is needed to determine the diagnosis. Some neck lumps can be removed under local anaesthesia, while others may require general anaesthesia (full body anaesthesia). Sometimes, a CT or MRI scan can provide helpful information before deciding whether to remove the lump.

Nasal endoscopy is usually part of the examination and necessary if nose cancer is suspected or needs to be excluded. Nasal endoscopy involves passing a thin flexible camera into the nose to examine the nose and throat. The examination only takes a few minutes and is usually painless. Nasal endoscopy can examine the throat down to the level of the voice box; if examination is required further into the food passage, then oesophagoscopy may be recommended.

For suspected cancer inside the nose or throat, a tissue specimen must be sent to the laboratory to establish the diagnosis. For nose cancer, this may be performed in the clinic using local anaesthesia, and the endoscope to guide the biopsy. With cancers deep in the throat, for example at the voice box, general anaesthesia and special instruments are usually needed to access the area.

ENT cancers can be treated successfully, and the earlier cancer is diagnosed, the easier it is to treat and cure. Side effects from early treatment are also likely to be less. It is important to seek medical advice early if you detect any warning signs as this can mean an earlier diagnosis if a cancer is present.

Surgery, radiotherapy and chemotherapy are the main treatments for head and neck cancers. The exact treatment option varies according to the type and extent of the cancer.

Nasopharyngeal cancer

Radiotherapy and chemotherapy (given directly into a vein) are usually administered over several weeks to treat the cancer.

Because of its location in the back of the nose, surgery is not normally used to treat nasopharyngeal cancer, but is required to obtain the initial diagnosis.

Thyroid cancer

Surgery is required to remove the cancer and any involved lymph nodes in the neck.

Radioactive iodine treatment is often given several weeks after surgery to clear remaining cancer cells in the body. This is taken by the patient in capsule or liquid form. The radioactive iodine targets and kills any remaining thyroid cells.

Lymphoma

Chemotherapy is usually required as the lymph system, which occurs throughout the whole body, is involved. Radiotherapy may be used when the cancer only involves one part of the body.

Other treatments such as antibody or immunotherapy may be used. This involves administering medication, which attaches to cancer cells and stimulates the immune system to attack the cells.